Denied Adult Day Health Clients Ponder the Future
By Matt Perry
As a child, Lyudmia Shnaydman survived the horrors of World War II, though she lost her entire family. As an older adult she suffers from no fewer than four serious, chronic health problems. Now the state of California is giving her nightmares.
Next week, the state has told Shnaydman, she will lose her access to adult day health care under tighter eligibility rules adopted last year.
While she suffers from a litany of health problems including hypertension, scoliosis, arthrititis and thoracic spine pain, these pale in comparison to the mix of terror, insomnia and depression that consume her once more.
Only six years old when World War II reached into her Ukrainian village, German planes bombed and strafed her home town, killing her entire family of Jewish parents, grandparents, sisters and aunts.
Three days a week Shnaydman now attends Altamedix ADHC in Sacramento along with over 200 other clients from the former Soviet Union, where she is examined by nurses, receives physical therapy, eats three times daily, sings songs, and converses with friends.
“After this letter I stay home and I cry a lot because if I miss this facility I don’t know what happens to me,” says Shnaydman, 76. “I will stay home all seven days. Every day I will stay home.”
Shnaydman has now unplugged her TV set, stopped calling friends, and remains inside.
Shnaydman is just one casualty of a budget rollercoaster that last year eliminated the entire Adult Day Health Care (ADHC) program of 35,000 clients, only to see it resurrected after a lawsuit as the new, smaller Community Based Adult Services (CBAS).
After a one-month delay, CBAS is slated to begin in April with 20-30% fewer clients than its predecessor. A lawsuit filed this week could delay the transition and save Shnaydman’s benefits for now. If that fails, Shnaydman, like many denied approval into the new program, is appealing the decision with the help of the center.
Hoping for a positive judicial ruling, Altamedix will continue serving the recent widow, says Altamedix program director Sergey Ionov.
Across the state, denied participants, their families, and providers are scrambling to find alternatives or prepare appeals, unsure what they will do with the disabled and elderly clients who depend on adult day health as a cornerstone to their care – and is a welcome respite for exhausted families.
One ADHC executive summarized the past year.
“Horrendous confusion and stress that this whole process has put the participants through,” says Judy Canterbury, an administrator at three of California’s over 250 centers.
Supporters say the centers are the best and most cost-effective ways of handling this vulnerable population.
Medi-Cal pays providers $76.27 a day for each client, half of which is reimbursed by the federal government. Nursing homes typically cost four to five times that amount.
“We really are the hub of their medical care,” says Dawn Myers Purkey, program manager for Yolo Adult Day Health Center in Woodland.
Squeezed by budget woes, however, state officials targeted the program for cutbacks, anticipating that only half of existing participants would qualify for the new program. Denials targeted clients attending for socialization or treatment they could get more cheaply elsewhere.
Assessments based on “medical necessity” by nurses from Medi-Cal, which administers the program, have since boosted that figure to an estimated 70-80%.
Denied clients receive case managers who try to find them alternatives to adult day health.
But this has raised the ire of many providers who say that in most counties, proper alternatives simply don’t exist.
In Contra Costa County, Laura Gaston (not her real name) cares for her 73 year-old mother who had a stroke 15 years ago. The elderly woman still suffers from seizures, falls, and poor short-term memory. She wears two braces – one leg and one arm – and spends most of her time in a wheelchair.
After her mother’s denial, Gaston received a brochure and phone call from Contra Costa Health Plan detailing other options.
One was the Brentwood Senior Citizens Club, which offers social activities like dancing, pinochle, and stretching classes.
“She couldn’t go to the senior citizen place,” says Gaston. “It just wouldn’t work. I’d have to stay there with her.”
The recreation supervisor for the city of Brentwood, which operates the Senior Citizens Club, says no one from Contra Costa Health Plan contacted her about transitioning adult day health club patients there.
“The seniors that come to our senior center need to be able to go to the restroom on their own,” says Olivia Alvarez. “(Seniors) are buzzing in and out of the center to participate in activities.”
Last spring, Mendocino county’s only ADCH closed its doors, folding some of its services into the Ukiah Senior Center, which still offers a Lunch Bunch program that provides social activities and minor medical oversight for $25 a day.
“The ones we could no longer support ended up in (skilled nursing), which is really sad,” says Marilyn DeFrange, general operations manager for the senior center. DeFrange estimates that half of the 25 former ADHC participants are now in institutions.
While some former clients still attend the senior center, many remain shut-ins.
“They wind up staying home and being alone, sitting around twiddling their thumbs, being depressed, and perhaps not eating,” says DeFrange.
A year ago the Sierra LifeNet Adult Day Health Center in Tuolumne County also shut its doors. Client Sue Barnett recalls the final words of the facility’s director.
“We have no more money. Tomorrow’s the last day,” sighs Burnett. “It sort of hit everybody like a bombshell.”
After the closure, Barnett watched several of her friends decline and move into skilled nursing – which she called a local growth industry.
“They were adding on to their rest homes because they knew they were probably going to be having new customers,” says Barnett.
At 58 years old, she stays at home, lives on just $830 a month and clearly misses her friends from the center.
“I had a reason to get up in the morning,” Barnett recalls.
While most clients are appealing their denials, clients of Bakersfield’s ElderLife Adult Day Health Care may not bother. Last month they received shocking news that Kern County was shutting the center’s doors completely at the end of March, leaving 51 clients and their families angry, confused, and clambering for options.
Johnny Elijah has been a client at ElderLife for the past 17 years.
Thirty years ago, while putting on his work boots outside in the early morning light, Elijah was cracked in the skull with a metal object and left for dead.
After 10 years of skilled nursing, and three more in assisted living which often left him soaked in his own urine, Elijah used his laminated spell-a-word board to ask his family “Take me home.”
Lee Perry and his wife have taken care of Elijah, his half-brother, since the day Perry retired.
What will Perry do next?
“I haven’t had a whole lot of time to think about it,” says Perry, 73.
While there is another adult day health facility across town, it caters to the developmentally disabled – fast-paced, sometimes frantic clients dangerous to the weak and fragile.
Perry reflects on the conundrum in a slow drawl, wishing there were easy options to allow him a break from the 24-hour cycle of care, which included going out to breakfast with his wife.
“That’s going to stop because we have to be here with him,” says Perry. “It’s going to be rough on us I know.”